MEDICARE: GEORGE PERRY GRIMES PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	32666	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	87127A	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1699703645
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE PERRY GRIMES PHD

Provider Business Mailing Address
First Line	:	480 MARINERS DR
Second Line	:
City	:	KEMAH
State	:	TX
Zip	:	77565-2261
Country	:	US
Telephone Number	:	979-417-4294
Fax Number	:	281-538-8069

Provider Business Practice Location Address
First Line	:	480 MARINERS DR
Second Line	:
City	:	KEMAH
State	:	TX
Zip	:	77565-2261
Country	:	US
Telephone Number	:	979-417-4294
Fax Number	:	281-538-8069

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	05/20/2013

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Directions to “ GEORGE PERRY GRIMES PHD” Practice Location

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